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Published on: September 2, 2021
Pericardial Diseases in COVID19: a Contemporary Review
Muhammad M Furqan1, Beni R Verma1, Paul C Cremer1
1Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
Insights
Coronavirus disease 2019 (COVID-19) can affect the pericardium, leading to inflammation. Early diagnosis and management of pericardial involvement in COVID-19 patients are crucial for recovery.
Area of Science:
- Cardiology
- Infectious Diseases
- Pathophysiology
Background:
- Coronavirus disease 2019 (COVID-19) is known to affect multiple organs, including the heart.
- Pericardial involvement is an emerging manifestation of COVID-19, requiring increased clinical suspicion.
Purpose of the Study:
- To review pathophysiological mechanisms of pericardial involvement in COVID-19.
- To summarize pericardial manifestations and patient cases related to COVID-19.
- To outline current treatment strategies for pericarditis secondary to COVID-19.
Main Methods:
- Review of existing literature on COVID-19 and pericardial disease.
- Analysis of proposed pathophysiological mechanisms, including hyperinflammatory responses.
- Summary of diagnostic approaches and clinical presentations.
Main Results:
- COVID-19-associated pericarditis is proposed to result from a hyperinflammatory reaction.
- Diagnosis relies on clinical signs, inflammatory markers, ECG, and echocardiography, with multimodality imaging offering additional value.
- While most cases are managed medically, some may progress to pericardial tamponade requiring drainage.
Conclusions:
- Pericardial involvement is a significant clinical manifestation of COVID-19.
- Prompt diagnosis and tailored management plans are essential for favorable outcomes.
- Timely intervention, especially in cases of tamponade, leads to complete recovery.
Purpose Of Review:
Coronavirus disease 2019 (COVID19) involves the heart, including pericardium. This article reviews the possible pathophysiological mechanisms in pericardial involvement in COVID19 and pericardial manifestations of COVID19. It also summarizes the patients with pericarditis secondary to COVID19 and outlines the contemporary treatment strategies in this patient population.
Recent Findings:
A high degree of suspicion is required to identify the pericardial involvement in COVID19 patients. It is proposed that an underlying hyperinflammatory reaction in COVID19 leads to pericardial inflammation. Acute pericarditis with or without myocardial involvement is diagnosed on clinical presentation, serum inflammatory markers, electrocardiogram, and echocardiogram. Multimodality imaging may also have an additional diagnostic value. Patients are usually managed medically, but some patients develop a life-threatening pericardial tamponade necessitating pericardial drainage. Pericardial involvement is an important clinical manifestation of COVID19 requiring a proper workup. Timely diagnosis and a specific management plan based on the presentation and concomitant organ involvement usually lead to a complete recovery.
